Provider Demographics
NPI:1861869240
Name:SANDER-THOMPSON, BETH A (CNP)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:A
Last Name:SANDER-THOMPSON
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:A
Other - Last Name:SANDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:4126 N HOLLAND SYLVANIA RD STE 220
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-3537
Mailing Address - Country:US
Mailing Address - Phone:419-517-7665
Mailing Address - Fax:419-517-7598
Practice Address - Street 1:3533 SOUTHERN BLVD STE 4600
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-1273
Practice Address - Country:US
Practice Address - Phone:937-296-0167
Practice Address - Fax:937-297-2330
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-01
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH282883363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily